Background <p>Studies show that the mental health of children has deteriorated since the COVID-19 pandemic and due to ongoing crises. The aim of this study is to examine the development of the prevalence of behavioral problems in recent years based on school entry data and to identify correlations and risk factors. Comparisons are made between medical and parental assessments.</p> Methods <p>The school entry data of the Hannover region for the years 2021/2022 to 2023/2024 were compared with data from 2010 to 2014. Risk factors were identified using regression analyses. Parental assessments, measured with the Strengths and Difficulties Questionnaire (SDQ), were compared with medical assessments.</p> Results <p>The prevalence of behavioral problems has increased from 9.4% to 13.5% in the medical assessment and from 7.9% to 11.2% in the parental assessment. The proportion of children receiving treatment has decreased from 6.0% to 5.2%. Positive social-emotional development is associated with higher parental education, growing up with both parents, attending kindergarten for at least three years, low media consumption, and participation in sports clubs. Medical and parental assessments of behavioral problems largely align.</p> Discussion <p>The discrepancy between the number of children with behavioral problems and those in treatment could indicate insufficient care. There is a&#xa0;need for counseling regarding certain risk factors. The school entry examination presents an opportunity for counseling, but additional low-threshold services are needed, especially for vulnerable families.</p>